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<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Edit Profile Details</title>
</head>

<body>
<img src="/top.JPG" width="725" height="126" />
<br /><br />
<form action="/CheckAddAdministrator.php" method="post">
  <table width="726" border="0">
    <tr>
      <td width="278" bgcolor="#0099FF">CUID:</td>
      <td colspan="2"><input type="text" name="CUID" maxlength="7"/></td>
    </tr>
    <tr>
      <td bgcolor="#0099FF">Department Name:</td>
      <td colspan="2">
      <select name="departmentName">
<option value="APAM">Applied Physics and Applied Mathematics</option>
<option value="BME">Biomedical Engineering</option>
<option value="CHEME">Chemical Engineering</option>
<option value="CIVIL">Civil Engineering and Engineering Mechanics</option>
<option value="CS">Computer Science</option>
<option value="EEE">Earth and Environmental Engineering</option>
<option value="EE">Electrical Engineering</option>
<option value="IEOR">Industrial Engineering and Operations Research</option>
<option value="ME">Mechanical Engineering</option>
</select>
      </td>
    </tr>
    <tr>
      <td>&nbsp;</td>
      <td width="259">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#0099FF">Password:</td>
      <td colspan="2"><input type="password" name="password1" maxlength="20"/></td>
    </tr>
    <tr>
      <td bgcolor="#0099FF">Repeat Password:</td>
      <td colspan="2"><input type="password" name="password2" maxlength="20"/></td>
    </tr>
    <tr>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#0099FF">First Name: </td>
      <td colspan="2"><input type="text" name="firstName" maxlength="12"/></td>
    </tr>
    <tr>
      <td bgcolor="#0099FF">Middle Name:</td>
      <td colspan="2"><input type="text" name="middleName" maxlength="12"/></td>
    </tr>
    <tr>
      <td bgcolor="#0099FF">Last Name:</td>
      <td colspan="2"><input type="text" name="lastName" maxlength="12"/></td>
    </tr>
    <tr>
      <td height="50" bgcolor="#0099FF">Sex: </td>
      <td colspan="2">&nbsp;&nbsp;Male
        <input type="radio" name="sex" value="Male"/> &nbsp;&nbsp;&nbsp;Female<input type="radio" name="sex" value="Female" /></td>
    </tr>
    <tr>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#0099FF">Address Line 1:</td>
      <td colspan="2"><input type="text" name="address1" maxlength="40"/></td>
    </tr>
    <tr>
      <td bgcolor="#0099FF">Address Line 2:</td>
      <td colspan="2"><input type="text" name="address2" maxlength="40"/></td>
    </tr>
    <tr>
      <td bgcolor="#0099FF">City:</td>
      <td colspan="2"><input type="text" name="city" maxlength="15"/></td>
    </tr>
    <tr>
      <td bgcolor="#0099FF">State:</td>
      <td colspan="2"><input type="text" name="state" maxlength="15"/></td>
    </tr>
    <tr>
      <td bgcolor="#0099FF">Country:</td>
      <td colspan="2"><input type="text" name="country" maxlength="15"/></td>
    </tr>
    <tr>
      <td bgcolor="#0099FF">Zip-Code:</td>
      <td colspan="2"><input type="text" name="zipCode" maxlength="5"/></td>
    </tr>
    <tr>
      <td bgcolor="#0099FF">Cell Number:</td>
      <td colspan="2"><input type="text" name="cellNumber" maxlength="10"/></td>
    </tr>
    <tr>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr>
      <td><div align="right">
        <input type="submit" value="Submit!" />
      </div></td>
      <td>&nbsp;&nbsp;
      <input type="reset" value="Reset Data!" /></td>
      <td width="175">&nbsp;</td>
    </tr>
  </table>
  <p>&nbsp;</p>
</form>

</body>



</html>
